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Natalie's new face

Natalie's "new face"

Meet Natalie Merlo, an 18-year-old college freshman from
Seattle, as she is about to embark on a journey she’s been waiting for her
whole life.

Natalie was diagnosed with Crouzon syndrome as a child,
which is a rare disorder that causes the skull’s bones to fuse prematurely,
affecting not only appearance but also vision and breathing as well.

“When people first meet me, I can see that they know there
is something off about my appearance, but they can’t place it,” Natalie told
CBS News last summer.

Complex craniofacial surgery could help Natalie, but doctors
had to wait until she stopped growing. This year, they decided to perform the surgery
before Natalie would attend Villanova University in Philadelphia. Here she is
the day of the surgery.

With help from Natalie and doctors at Seattle Children’s
Hospital, follow along to see Natalie’s long-awaited transformation unfold…

Credit: Seattle Children's Hospital

Natalie's "new face"

Here’s Natalie at age 3, when she was first diagnosed with
Crouzon syndrome, a genetic disorder that prevents the skull from growing
naturally. The National Institutes of Health estimates about 16 in every
million children are born with Crouzon.

Natalie's "new face"

Natalie’s plastic surgeon, Dr. Richard Alan Hopper, surgical
director of the Craniofacial Center at Seattle Children’s Hospital, explained
to CBS News that Natalie did not have the telltale genetic mutation seen with
Crouzon syndrome, but something in her genetic makeup stopped the middle and
upper portion of her face from growing properly.

Many kids with more severe cases get skull surgery between 7
and 9 years old, her doctor pointed out.

Here’s Natalie when she was 5 years old.

Credit: Seattle Children's Hospital

Natalie's "new face"

Natalie’s case was milder than others with Crouzon, but her
skull’s shape prevented her from breathing through her nose and her underbite
made her have to chew exclusively with her back teeth, what she described as
chewing “like a cow.” She did not have sufficient facial bone growth around her
eyes and they were frequently dry, and needed extra protection during sports
and other activities.

Here’s Natalie pictured at 9 years old.

Credit: Seattle Children’s Hospital

Natalie's "new face"

“I knew I’d get surgery since I was 8,” said Natalie. “I’ve had like 10 years to come to terms to it.”

Here’s Natalie pictured at 9 years old.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Hopper and his team decided to wait until Natalie finished
growing, so she’d have more bone protecting her eye. He said there’s
a stigma associated with the condition, in which people may misperceive someone
with Crouzon to be less intelligent because the eyes are more prominent and
upper teeth are behind the lower teeth.

“Whereas Natalie as an incredibly intelligent, vivacious
young lady,” Hopper told CBS News the day of the surgery, about 15 minutes
before he had to scrub in. “This (procedure) gets her bones where they should
have been in the first place.”

Here’s Natalie at age 13.

Credit: Seattle Children’s Hospital

Natalie's "new face"

"I'm excited to not worry about playing a pickup game of
softball in college without running for my facemask, or biting into a sandwich
and not having to slop the bite around in my mouth, just calmly chewing with my
mouth closed,” Natalie said of what she looks forward to most. “They sound like
small, trivial things, but it's the stuff I have been so self-conscious about
that I can finally let go of. And I know it will feel great.”

Doctors took this image of her at 15 years old.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Years before the surgery would take place, Natalie got under the
care of Seattle-based orthodontist Dr. Hitesh P. Kapadia, whom she considers to
be “like an uncle to me.”

She had to see the orthodontist every three weeks to make
sure her teeth were sufficiently moved to make enough space in her mouth
for the surgery.

“He’s done all sorts of crazy braces magic,” she joked.

Here’s Natalie when she was 16 years old.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Natalie’s surgery following her high school graduation was
nearing.

“All this week I have had a pit in my stomach,” she said.
But the day before the surgery, she felt surprisingly calm after meeting with
her anesthesiologist and child life specialist.

“There is no stopping what is to come, and the faster it
comes the faster it is over,” said Natalie.

Credit: Seattle Children’s Hospital

Natalie's "new face"

"I want to see what the intended version of myself
would look like, if I had never had a craniofacial condition,” said Natalie.
“And I think this surgery will show me that.”

Here is Natalie’s side profile at age 18, right before the surgery
takes place.

Credit: Seattle Children’s Hospital

Natalie's "new face"

The day of the surgery finally arrives. Hopper (right)
expects when all is said and done, Natalie’s breathing will improve and she’ll
be able to bite into an apple with her front teeth for the first time.

“My personal gratification comes from their enjoyment with
the results of the surgery,” Hooper, a father of twin girls, said before the
procedure. “She’s excited, so it makes me excited.”

Credit: Seattle Children’s Hospital

Natalie's "new face"

Today is the first surgery she will require for her
transformation – “the big one,” as Hopper calls it.

Doctors will make an ear-to-ear incision and fold Natalie’s
forehead over her eyes. Using saws and chisels, they will separate all of her
facial bones from the base of her skull. Then the team will attach an external
frame (pictured) called a halo to her face that will help get her bones into
position.

A family member has to turn a screw one millimeter a day to
close the gap in facial bones and maintain healing.

Credit: Seattle Children’s Hospital

Natalie's "new face"

The surgery will take place with a full team on hand, including Natalie’s orthodontist, who designed a custom splint that surgeons will wire under her skin to her cheekbones and jaw. This is what doctors will be pulling on to adjust her bones.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Similar surgeries 15 to 20 years ago required using screws and bone
grafts from the ribs to hold the face in a better position. Doctors also used
to pull directly on the cheekbones, which would leave scarring, Hopper added.
The newer techniques will aid in Natalie’s recovery.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Hopper says a
team of more than 15 medical staffers at Seattle Children’s Hospital -- including
a pediatrician, geneticist, pediatric dentist, ear nose and throat doctor, and
hearing and speech specialists -- has followed Natalie’s care.

“This surgery could not be done safely or well by a single
surgeon,” he said. “You need a whole team.”

In this image, surgeons prep Natalie.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Hopper says the surgery will be tough for Natalie, noting she will be kept asleep in the intensive care unit for the next three days
after it’s completed.

Afterwards, doctors will slowly wake her up and then over
the next two weeks, she’ll have the screw on the device turned until her cheek
bones are in the right position relative to her eyes.

Credit: Seattle Children’s Hospital

Natalie's "new face"

The team continues Natalie’s surgery. Hopper said patients
like Natalie used to keep the halo device on for three months after the
procedure is complete, but he hopes to get it taken off of her within six
weeks.

“Her cheek bones will be in the right position, she’ll have
a dramatic change of appearance,” he said.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Natalie’s surgery took place on a Friday, and she said she would not remember anything until she was awakened the following Monday.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Here is Natalie with a nurse once she awoke from surgery
that Monday. She had a breathing tube placed in during the procedure, and was about to be moved from the ICU.

Natalie did not take any pain relievers, and more than
anything wanted to leave the hospital, but she’d have to remain another two
days.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Next she’ll return to the hospital in about three weeks to
get the splint removed.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Here is Natalie with her orthodontist, Dr. Kapadia. She says he is “like an uncle” since they have gotten to know each other well over the
years during frequent visits to make sure her teeth were perfectly in place
before surgery.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Natalie leaves the hospital after the first surgery and returns home,
but her work is only beginning. The “turning phase” is tough on patients,
explains Hopper, because it feels like a surgery that’s extended over two
weeks. He anticipated she’d feel weak and down in the dumps, but once the
turning phase ends, she’ll perk up.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Here is Natalie with Dr. Hopper at her follow-up
appointment, looking over imaging scans of her changing skull.

Credit: Seattle Children’s Hospital

Natalie's "new face"

This image shows the halo device attached to Natalie's skull. Note the wiring that connects to her splint that helps shift her facial bones when the screw on the halo device is turned.

Credit: Seattle Children's Hospital

Natalie's "new face"

Here is Natalie recovering at home with the halo device.

During her recovery, she was cleared by doctors to take in a One Direction concert.

Credit: Seattle Children’s Hospital

Natalie's "new face"

Natalie awaits her second surgery to remove the splint and halo device. She anticipates it will feel like getting teeth pulled, as doctors
split the wires.

“I’m excited to go back out in public and not have people
stare at me, or ask me questions or wondering what’s on my face,” she said. “I
just want the whole thing to be gone.”

Credit: Seattle Children’s Hospital

Natalie's "new face"

Natalie said she has a mental picture of what she’ll look
like with her splint gone.

“I think I’m going to be really happy with the results,” she
said.

Credit: Seattle Children’s Hospital

Natalie's "new face"

This image shows Natalie with the halo removed. The transformation is dramatic.

Credit: Seattle Children’s Hospital

Natalie's "new face"

The happy, soon-to-be college freshman is seen here before she departs to
Villanova. She still has braces, but expects them to be removed down the road.
Next up for Natalie, she may need a more standard upper jaw surgery to bring
her upper teeth closer to her lower teeth, then “she should be good to go for
the rest of her life,” said Hopper.